Provider Demographics
NPI:1629536362
Name:JACKSBORO URGENT CARE
Entity type:Organization
Organization Name:JACKSBORO URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:423-907-8186
Mailing Address - Street 1:2707 JACKSBORO PIKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757
Mailing Address - Country:US
Mailing Address - Phone:423-907-8186
Mailing Address - Fax:423-907-8187
Practice Address - Street 1:2707 JACKSBORO PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757
Practice Address - Country:US
Practice Address - Phone:423-907-8186
Practice Address - Fax:423-907-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care